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    v1.0.28
    OpenPayerBilling CodesDiseases and Disorders of the Kidney and Urinary TractDRG 684-renal-failure-without-cc-mcc
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    Renal Failure without CC/MCC: Inpatient Reimbursement Overview

    DRG 684 addresses inpatient stays for renal failure without Major Complication or Comorbidity or Complication or Comorbidity, encompassing acute and chronic renal insufficiency of moderate severity. Proper coding and documentation determine assignment to this Diagnosis-Related Group and therefore influence Medicare reimbursement under the inpatient prospective payment system.

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    DRG 684 Overview

    DRG 684 covers inpatient admissions for renal failure without a major complication or comorbidity and without a complication or comorbidity. It includes patients treated for acute or chronic renal insufficiency when no higher-severity diagnoses are present. This Diagnosis-Related Group matters for Medicare payment because it groups cases of moderate clinical complexity into a standardized reimbursement pathway under prospective payment. Accurate coding of renal failure and exclusion of Major Complication or Comorbidity and Complication or Comorbidity affects case assignment and payment level.

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    National Payment Rates

    Benchmark payments across commercial payers span roughly from about $1.1K (BCBS p25) up to $24K (Anthem max), with payer medians generally between about $5.7K and $11K. The widest spread appears between Anthem’s maximum ($24K) and BCBS’s lower quartile (~$1.1K), indicating considerable variation across payers. See the table and chart below for payer-specific distributions and percentile detail.

    The CMS 2023 data represent national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 684. Values reflect national aggregates for Medicare FFS cases in 2023.

    Average Total PaymentAverage Submitted ChargesAverage Medicare PaymentTotal Discharges
    $5.9K$27K$4.1K7.2K

    Patient Population

    This DRG’s population skews toward Medicare-age patients, with a larger share of discharges coming from the Medicare fee-for-service population than from commercial plans. Working-age commercial payers contribute a minority of cases, making the overall mix more Medicare-weighted than purely working-age. Expect a primarily Medicare-age cohort with a smaller, mixed commercial component.

    State Payment Rates

    State: Alaska1 / 49

    Alaska Benchmarks

    Alaska’s payer means for DRG 684 range from 9.3K (Anthem and Blue Cross Blue Shield) up to 14K (Cigna), a spread suggesting meaningful regional variability across payers. Cigna’s mean of 14K stands out as higher than many national benchmark means shown for comparable payers. Reference the table and chart below for payer-specific percentiles and distribution detail.

    Key Insights for Alaska

    • Cigna is the highest-paying payer in Alaska with a mean of 14K, while Anthem and Blue Cross Blue Shield are the lowest-paying payers at 9.3K.
    • Alaska’s mean rates span a relatively wide range (9.3K to 14K), with Cigna notably above the national mean benchmarks for some payers, indicating higher regional reimbursement for DRG 684 compared with several national averages.

    Clinical Trials

    • Acute supportive care trials investigating timing and modality of renal replacement therapy (RRT) for hospitalized patients with acute renal failure without major comorbid complications. These studies enroll adult inpatients with new-onset acute kidney injury attributed to sepsis, ischemia, or nephrotoxins who do not meet criteria for CC/MCC, comparing early versus standard initiation of intermittent versus continuous RRT or optimized conservative management. Findings inform acute management protocols, resource utilization in the inpatient setting, and short-term costs that directly affect DRG-level reimbursement and bed-level planning for hospitals and payers.
    • Comparative effectiveness research comparing fluid management strategies, diuretic protocols, and nephrotoxin stewardship to prevent progression of renal dysfunction in medical and surgical inpatients. Trials or pragmatic studies focus on heterogeneous ward and ICU populations without major complications, assessing outcomes such as recovery of renal function, need for RRT, length of stay, and readmission rates. This research is relevant to clinicians and payers because modest changes in progression rates and LOS among this DRG cohort can substantially impact hospitalization costs and downstream utilization.
    • Post-discharge outcomes and care-transition studies tracking recovery trajectories, outpatient follow-up strategies, and readmission prevention for patients discharged after an episode of renal failure without CC/MCC. Cohort studies and interventional trials evaluate models like early nephrology follow-up, home-based monitoring of kidney function and medication reconciliation, and patient education to reduce 30–90 day readmissions and progression to chronic kidney disease. Results guide discharge planning, bundled payments, and payer decisions about coverage for post-acute services that can reduce avoidable rehospitalizations and long-term dialysis initiation.

    Related Codes

    650-KIDNEY-TRANSPLANT-WITH-HEMODIALYSIS-WITH-MCC

    Kidney Transplant with Hemodialysis with Major Complication or Comorbidity: Inpatient Reimbursement Overview

    651-KIDNEY-TRANSPLANT-WITH-HEMODIALYSIS-WITHOUT-MCC

    Kidney Transplant with Hemodialysis without MCC: Inpatient Reimbursement Overview

    652-KIDNEY-TRANSPLANT

    Kidney Transplant: Inpatient Reimbursement Overview

    653-MAJOR-BLADDER-PROCEDURES-WITH-MCC

    Major Bladder Procedures with MCC: Inpatient Reimbursement Overview

    654-MAJOR-BLADDER-PROCEDURES-WITH-CC

    Major Bladder Procedures with CC: Inpatient Reimbursement Overview

    655-MAJOR-BLADDER-PROCEDURES-WITHOUT-CC-MCC

    Major Bladder Procedures without CC/MCC: Inpatient Reimbursement Overview

    656-KIDNEY-AND-URETER-PROCEDURES-FOR-NEOPLASM-WITH-MCC

    Kidney and Ureter Procedures for Neoplasm with MCC: Inpatient Reimbursement Overview

    657-KIDNEY-AND-URETER-PROCEDURES-FOR-NEOPLASM-WITH-CC

    Kidney and Ureter Procedures for Neoplasm with CC: Inpatient Reimbursement Overview

    658-KIDNEY-AND-URETER-PROCEDURES-FOR-NEOPLASM-WITHOUT-CC-MCC

    Kidney and Ureter Procedures for Neoplasm without CC/MCC: Inpatient Reimbursement Overview

    659-KIDNEY-AND-URETER-PROCEDURES-FOR-NON-NEOPLASM-WITH-MCC

    Kidney and Ureter Procedures for Non-Neoplasm with MCC: Inpatient Reimbursement Overview

    Showing 1–10 of 41

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Mean Rates by Payer — National — DRG 684
    Mean Rates by Payer — Alaska — DRG 684